EyeMed Vision Care Plan
The Plan offers in-network and out-of-network benefits. When using a participating network provider, you pay a modest copayment for exam and materials as shown in the Schedule of Benefits. The out-of-network benefit allows you to select any licensed non-network provider. As the plan participant, when visiting a non-network provider, you pay the full fee to the provider and EyeMed Vision will reimburse you for services rendered up to the maximum allowance. There are no copays or deductibles when using an out-of-network provider.
Your benefit includes annual eye exam coverage, eye glasses or contact lenses. In-network for frames there is no member cost up to the $180 allowance. In-network for contact lenses there is no member cost up to the $150 allowance. The standard contact lens fit and follow-up member fees will not exceed $40. See Schedule of Benefits below for further details and out-of-network reimbursement amounts.
Schedule of Benefits
Covered Benefit |
In-Network |
Out-of-Network |
Exams - Once Every Calendar Year |
$10 copay | Up to $40 |
Lenses - in lieu of contact lenses - Once Every Calendar Year | ||
Single Vision |
Covered in full after a $10 copay
|
up to $40 |
Bifocal | Covered in full after a $10 copay | up to $60 |
Trifocal | Covered in full after a $10 copay | up to $80 |
Lenticular |
Covered in full after a $10 copay | up to $80 |
Frames - Once Every Calendar Year | $0 copay, $180 allowance, 20% off balance over $180 | Up to $45 |
Contact Lenses in Lieu of lenses – Once every Calendar Year* | ||
Conventional
|
$0 Copay, $150 allowance, 15% off balance over $150
|
Up to $105
|
Disposable
|
$0 Copay, $150 allowance, plus balance over $150
|
Up to $105
|
Medically Necessary Contact Lenses
|
Covered in full
|
Up to $210
|
Lens Options
|
Standard Scratch-Resistant and Polycarbonate for Dependent Children (up to age 19) – covered in full.
Other lens options are offered at a discount.
|
Range from up to $5 - $20 |
* During any plan year, you may elect either the spectacle lens or contact lens benefit, but not both.
If there are any differences in this document and the Group Policy, the Group Policy is the governing document. Please consult the applicable policy/certificate of coverage for the full description of benefits, including exclusions and limitations.
Any copayment or out-of-pocket cost may be reimbursed through your Medical Expense FSA.
See the FSA section for a partial list of eligible expenses or visit TASC's website at www.tasconline.com for the full version of eligible expenses.
EyeMed Vision Plan In-Network
- The eye exam, contact lenses (new or replacement), or lenses are provided once every calendar year regardless of prescription change. Frames are provided once every calendar year.
- Your out-of-pocket cost for the service rendered is paid by you upon receipt of services. Oversize lenses, tinted lenses, sunglasses, and nonstandard and photochromatic lenses may be purchased with an additional charge. Contact lenses are in lieu of lenses.
- There is no annual deductible with this plan.
How to use the EyeMed Vision In-Network Plan Benefits:
Using a Network Provider
- A list of participating optometrists and ophthalmologists can be accessed through eyemed.com. Benefits listed are valid at all participating eye doctors.
- Identification cards are not needed. Your eligibility for service is verified by identifying yourself as an EyeMed Vision Care Plan participant when you make an appointment with a participating eye doctor.
- The provider will handle all claim filing with EyeMed.
EyeMed Vision Out-of-Network Plan:
- You are responsible for payment of the entire fee. There will be a one-time reimbursement by the EyeMed Vision Plan up to the amounts listed on chart.
- The vision exam is provided once every calendar year, with a maximum $40 reimbursement.
- Lenses are provided once every calendar year, if needed, as determined by your optometrist or ophthalmologist.
- Frames are provided once every 12 months, if needed. Frames are limited to a maximum $45 benefit.
- Contact lenses will be provided once every 12 months under the plan, if needed, as determined by your optometrist or ophthalmologist. Payment will be made for only one pair of lenses, either single, bifocal, trifocal, or contacts during the calendar year. No lens benefits are available during the calendar year that contact lenses are elected.
How to use the EyeMed Vision Out-of-Network Plan Benefits:
- EyeMed Vision Out-of-Network vision benefits are valid at any licensed ophthalmologists, optometrists, optometrist, or optician.
- Visit www.eyemed.com and complete the claim form either online or by printing and mailing itemized receipts to EyeMed. Claim forms must be submitted within 15 months of the date of service. For complete terms and conditions, review the claim form.
Vision Plan General Exclusions
No benefits will be paid for services or materials connected with or changes arising from:
- Orthoptic or vision training, subnormal vision aids and any associated
supplemental testing; Aniseikonic lenses; - medical and/or surgical treatment of the eye, eyes or supporting structures;
- any Vision Examination, or any corrective eyewear required by a Policyholder
as a condition of employment; safety eyewear; - services provided as a result of any Workers' Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof;
- plano (non-prescription) lenses;
- non-prescription sunglasses;
- two pair of glasses in lieu of bifocals;
services or materials provided by any other group benefit plan providing vision care; - services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and services rendered to the Insured Person are within 31 days from the date of such order; or
- lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available.
Plan Details
Tools and Resources
EyeMed Vision
Member Service:
Enrollment
Your Benefits
FAQ's
Rates
Office of Risk and Benefits Management
1501 N.E. 2nd Avenue, Suite 335
Miami, Florida 33132
Mon - Fri, 8 a.m. to 4:30 p.m. ET
www.dadeschools.net
305-995-7129
FBMC Service Center
Mon - Fri, 7 a.m. to 7 p.m. ET
1-855-MDC-PS4U (1-855-632-7748)